Adolescent Physical Activity Survey Instrument (Attachment I)

The Family Life, Activity, Sun, Health, and Eating Study (NCI)

Documents and Forms

Document Name Document Type
Form 5 Adolescent Physical Activity Survey Instrument (Attachment I) Form and Instruction
5 Adolescent Physical Activity Survey Attach1_Teen Physical Activity Survey REV 2104.docx www.research-survey.org/efm/wsb.dll/s/1g3e Form and Instruction

Information Collection (IC) Details

IC Title:	Adolescent Physical Activity Survey Instrument (Attachment I)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5	Adolescent Physical Activity Survey	Attach1_Teen Physical Activity Survey REV 2104.docx	https://www.research-survey.org/efm/wsb.dll/s/1g3e	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Clinical, Basic, Population-based Research Studies of the National Institutes of Health	FR Citation: 67 FR 60776

Number of Respondents: 1,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.